【高血压英文课件】-Anesthesia

2007 PMCCAnesthesiaChapter 182007 PMCCAnesthesiaChapte1Chapter Outline Introduce students to1.Forms of anesthesia2.Anesthesia guidelines3.Anesthesia modifiers Chapter Outline Introduce stud2Anesthesia GuidelinesAnesthesia service includesUsual preoperative and postoperative visitsAdministration of the anesthetic for the site of surgeryAnesthesia care during the procedureAdministration of fluids and/or blood replacementInterpretation of noninvasive monitoring(blood pressure,ECG,temperature,oximetry,apnography,and mass spectrometry)TimeKey element for reimbursementStarts when anesthesiologist begins preparing patient in OR Ends when anesthesiologist no longer in personal attendance and patient is safely placed under postoperative supervisionAnesthesia GuidelinesAnesthesi3【高血压英文课件】-Anesthesia4【高血压英文课件】-Anesthesia5Anesthesia ModifiersThree sets of modifiers to considerPhysical statusHCPCSCPTCPT manual also includes codes for Reporting circumstances that could increase the difficulty of providing anesthesiaAnesthesia ModifiersThree sets6Physical Status ModifiersP1Normal,healthy patientP2Patient with mild systemic disease(eg,mild,benign,hypertensive heart disease)well controlled on medicationP3Patient with severe systemic disease(eg,benign,hypertensive heart and renal disease with congestive heart and renal failure)P4Patient with severe systemic disease that is a constant threat to life(eg,hypertrophic obstetric cardiomyopathy with ESRD)awaiting heart transplantP5 Moribund patient who is not expected to survive without surgeryP6A declared brain dead patient whose organs are being removed for donor purposesPhysical Status ModifiersP1No7CPT Modifiers22Unusual Procedural Services23Unusual Anesthesia(Identifies a procedure that usually requires no anesthesia or local anesthesia.Under unusual circumstances,general anesthesia is required)32Mandated Services51Multiple Services53Discontinued Procedure59Distinct Procedural Service(Identifies certain circumstances when a physician may need to indicate that a procedure/service was distinct or independent from other services performed on the same day)CPT Modifiers22Unusual Proced8HCPCS Level II ModifiersAAAnesthesia service performed personally by anesthesiologistADMedical supervision by a physician:more than four concurrent anesthesia proceduresG8Monitored anesthesia care(MAC)for deep complex,complicated,or markedly invasive surgical procedureG9Monitored anesthesia care for patient who has history of severe cardiopulmonary conditionQBPhysician providing service in a rural HPSAQKMedical direction of two,three,or four concurrent anesthesia procedures involving qualified individualsQSMonitored anesthesia care service(MAC)QXCertified registered nurse anesthetist(CRNA)service,with medical direction by a physicianQYMedical direction of one certified registered nurse anesthetist(CRNA)by an anesthesiologistQZCRNA service,without medical direction by a physicianHCPCS Level II ModifiersAAAne9Types of AnesthesiaGeneral AnesthesiaResults in loss of consciousnessProduces amnesia by blocking the awareness center in the brainCPT codes 00100-01999 represent general anesthesia unless code description states otherwiseRegional AnesthesiaBlocks all painful sensation to the specific region of the body innervated by the nerve or nerve plexus receiving the anesthetic Does not induce unconsciousnessTypes of AnesthesiaGeneral Ane10Types of AnesthesiaPeripheral Nerve BlocksAnesthetize individual nerves or nerve plexusesAnesthetic agent injected along the nerve rather than in the nerveCodes 64400-64530Used to describe these servicesNerve BlocksAnesthetize entire regionsSpinal AnesthesiaUsed for major procedures performed below level of the diaphragmRelatively safeProvides excellent muscle relaxationAccomplished by placing needle between the vertebrae and injecting anesthetic agent into the subarachnoid spaceFrequently used for pain management by anesthesiologistsTypes of AnesthesiaPeripheral 11Types of AnesthesiaEpidural AnesthesiaAchieved by injecting anesthetic agent into epidural space of thoracic or lumbar interspacesUsually avoid postoperative headachesIntravenous Regional BlocksUsed for some procedures on extremitiesPneumatic tourniquet applied to the limb and anesthetic agent is injected into the vein of the limb distal to the tourniquetField BlockUsed to form barrier between operative site and nervous systemAccomplished by multiple injections of local anesthetic agentLocal AnesthesiaApplied topically or by local infiltrationTypes of AnesthesiaEpidural An12Pain ManagementBenefits of proper pain managementShorter hospital staysIncreased mobilizationAcute PainMay be experienced during postoperative periodIncluded in surgeons feeShould only be turned over to a specialist when special circumstances warrant this level of serviceDocumentation must exist within medical record to indicate why services of anesthesiologist are neededPain ManagementBenefits of pro13Pain ManagementPain management options may includeCognitive,behavioral interventions such as education,relaxation,distraction,biofeedbackSystemic administration of a nonsteroidal anti-inflammatory drugs(NSAID)or opiatesPatient controlled analgesia(PCA)Spinal analgesiaIntermittent or continuous nerve blockPhysical agents(eg,massage)application of heat or cold modalitiesTranscutaneous electrical nerve stimulator(TENS)Chronic PainPain that does not resolve itself after 3-6 monthsTreated by variety of modalitiesPain ManagementPain management14Monitored Anesthesia Care(MAC)At times,an anesthesiologist may be called upon to Provide specific anesthesia services to a patient undergoing planned procedure,when patient may receive local or no anesthesia at allMAC should be reported by usingModifier QSDocumentation for medical necessityShould be evident in patients recordMedicareWants modifier G8 or G9 to be reported,if applicableMonitored Anesthesia Care(MAC15Procedural CodingSpine and Spinal Cord(00600-00670)New codes for 200700625 Anesthesia for procedures on the thoracic spine and cord,via an anterior transthoracic approach;not utilizing one lung ventilation00626 Anesthesia for procedures on the thoracic spine and cord,via an anterior transthoracic approach;utilizing one lung ventilationProcedural CodingSpine and Spi16Procedural CodingKnee and Popliteal Area(01320-01444)Regional anesthesia for knee surgery has three separate stepsEpidural/spinal anesthesia pain during the surgeryFemoral nerve block helps to manage pain after the surgerySedation during surgeryLower Leg(Below Knee,Includes Ankle and Foot)(01462-01522)Sciatic nerve used to numb only the leg and foot scheduled for surgeryOther leg not affectedWhen needle is close to correct position,patients foot will move on its ownOnce needle in proper position,nerve block medicine is injectedProcedural CodingKnee and Popl17Procedural CodingShoulder and Axilla(01610-01682)Nerves of should and armLocated on side of the neck,just above collarboneSingle injection into nerves will numb shoulder for 12-24 hoursNumbing affects only the side scheduled for surgeryRadiological Procedures(01905-01933)Interventional radiology using fluoroscopy,ultrasound,CT and MRIOften performed under local anesthesia with IV sedationGeneral anesthesia may be provided to patients who have had difficulty with sedation,or have coexisting medical conditionsProcedural CodingShoulder and 18Procedural CodingBurn Excisions or Debridement(01951-01953)Local or general anesthesiaMay be used when surgically debriding burnsTip:Burns in the ORmost burns(58%)in the OR are from devices used to warm the patient,including IV bags and warming devices,cautery devices caused from burns either by grounding pads or by causing a fire.Miscellaneous devices associated with burns included MRI,retractors,defibrillator paddles,and ECG leads.Procedural CodingBurn Excision19Procedural CodingObstetrical Anesthesia(01958-01969)Several different forms of anesthesia administered for childbirthMay be used independently or in conjunction with one anotherMost commonly administeredLocalRegionalProcedural CodingObstetrical A20Qualifying CircumstancesAnesthesiologists and CRNAs should use these add-on codes to reportSituations that make administering anesthesia particularly difficultMedicare does not pay for the following add-on services+99100 Anesthesia for a patient of extreme age,under one year or over 70+99116 Anesthesia complicated by utilization of total body hypothermia+99135 Anesthesia complicated by utilization of controlled hypotension+99140 Anesthesia complicated by emergency conditions(specify)Qualifying CircumstancesAnesth21Moderate Conscious Sedation(99143-99150)Located in the Medicine Section of CPTDrug induced depression of consciousnessAllows patient toRespond purposefully to verbal commands,either alone or accompanied by light tactile stimulationMay be administered inHospitalsOutpatient facilitiesModerate Conscious Sedation(922Moderate Conscious Sedation(99143-99150)Services that are included in moderate conscious sedationAssessment of patient(not included in intraservice time)Establishment of IV access and fluids to maintain patency,when performedAdministration of agent(s)Maintenance of sedationMonitoring of oxygen saturation,heart rate,and blood pressureRecovery(not included in intraservice time)Code 99143clarifies use of moderate conscious sedation services;sedation provided by same physician performing the diagnostic/therapeutic service,younger than 5 years of age,first 30 minutes of intraservice timeCodes 99144 and 99145further clarify age and time constraintsCode 99148clarifies use of a second provider;under age 5 years of age,first 30 minutes intraservice timeModerate Conscious Sedation(923Anesthesia CrosswalkAnesthesia codesDo not often correspond on a one-to-one basis with surgery codesApproximately 40,000 Surgical,medical and radiological procedures represented by nearly260 anesthesia codesAnesthesia codes Arranged based on anatomical areasImportant to utilize a crosswalk such asASA Crosswalk A Guide for Surgery/Anesthesia CPT CodesAnesthesia CrosswalkAnesthesia24The EndThe End25